Rachel Stancliffe, Director

Centre for Sustainable Healthcare

Sustainable Dentistry, 29th June 2018

An introduction to Sustainable Healthcare

@SusHealthcare

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HEALTHCARE

A. What is sustainable healthcare?

B. Why should healthcare professionals be concerned about sustainability?

C. What general steps have been taken to address sustainability in healthcare?

D. What steps have been taken towards sustainability in Dentistry?

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Healthcare challenges in the 21st century

SOCIAL

• Inequalities

• Safety / quality

• Patient experience

• Staffing / morale

ECONOMIC

• Rising demand

• Financial crisis

• Waste

ENVIRONMENTAL

• Climate change

• Air and water pollution

• Water scarcity

A. What is sustainable healthcare?

Environmental

Social Economic

Bearable

Sustainable

Viable

Equitable

BIOSPHERE

BIOSPHERE

A healthcare system is sustainable if it works within its financial, environmental and social resource limits, improving andprotecting health now and for future generations

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A. What is sustainable healthcare?

B. Why should healthcare professionals be concerned?

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B. Why should healthcare professionals be concerned about sustainability?

1. Climate Change is the biggest health threat of the 21st

century. Dr. Margaret Chan WHO Director-General

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‘Although vector-borne diseases will expand their reach and death tolls, the indirect effects of climate change on water, food security, and extreme climatic events are likely to have the biggest effect on global health.’

Lancet & UCL (2009). Managing the health effects of climate change.

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B. Why should healthcare professionals be concerned about sustainability?

1. Climate Change is the biggest health threat of the 21st

century

2. Healthcare contributes to climate change because of its high carbon emissions

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Greenhouse gas emissions of healthcare

Healthcare emits:

• 10% GHGs in the US1,

• 7% GHGs in Australia2, and

• 5% GHGs in England3

1 Eckelman M J, Sherman J (2016). Environmental Impacts of the U.S. Health Care System and Effects on Public Health. PLoS ONE 11(6): e0157014

2 Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planetary Health 2(1): e27-35

3 Sustainable Development Unit. (2016). Carbon Footprint update for the NHS in England.

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EstatesClinical

NHS England carbon footprint(22.8 million tonnes CO2e)

TravelCommissioned

Sustainable Development Unit (2016). Carbon Footprint update for the NHS in England.

Building energy use

Procured (pharmaceuticals, equipment, everything else)

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B. Why should healthcare professionals be concerned about sustainability?

1. Climate Change is the biggest health threat of the 21st

century

2. Healthcare contributes to climate change because of its high carbon emissions

3. Resources are finite (water and scarce metals)

4. Legal reasons and international agreements (2008 CCA)

5. Healthcare professionals are respected advocates

6. Sustainability can improve productivity and value, saving money along the way

Sustainable value in healthcare

Academy of Medical Royal Colleges, 2016 (with CSH)

(goods – harms)

Informed by patient values

outcomes

Value = environmental + social + financial costs

(the “triple bottom line”)

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A. What is sustainable healthcare?

B. Why should healthcare professionals be concerned about sustainability?

C. What general steps have been taken to make healthcare more sustainable?

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Summary of progress

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Summary of progress

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Governance

• Analysing healthcare’s greenhouse gas emissions and identifying its hotspots

• Securing support at executive level

• Developing organisational sustainable development management plans

• Developing partnerships to support the embedding of sustainable principles within healthcare

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‘No regret’ policies will improve health, enhance resilience, alleviate poverty and address inequality:

• Clean energy• Active travel• Housing improvements• Green spaces

Three min. film: http://www.thelancet.com/cms/attachment/2033405756/2049484881/mmc2.mp4

Sustainable clinical practice

Reduce carbon without reducing

health

Reduce activity

Prevention

Self care

Lean pathways

Reduce carbon intensity

Low carbon alternatives

Sustainable estates

Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110–11

Outcome needed

Secondary drivers

Primary driver

Primary driver

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Sustainable clinical practice

Reduce carbon without reducing

health

Reduce activity

Prevention

Self care

Lean pathways

Reduce carbon intensity

Low carbon alternatives

Sustainable estates

Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110–11

Outcome needed

Secondary drivers

Primary driver

Primary driver

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SUSTAINABLE

HEALTHCARE

Sustainable clinical practice

Reduce carbon without reducing

health

Reduce activity

Prevention

Self care

Lean pathways

Reduce carbon intensity

Low carbon alternatives

Sustainable estates

Mortimer-F. The Sustainable Physician Clinical Medicine 2010, Vol 10, No 2: 110–11

Sustainable clinical practice

Outcome needed

Secondary drivers

Primary driver

Primary driver

Infrastructure & process

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The 4 Principles of Sustainable Healthcare

• Prevention - promoting health and preventing disease by tackling the causes of illnesses and inequalities

• Patient self-care - empowering patients to take a greater role in managing their own health and healthcare

• Lean service delivery - streamlining care systems to minimise wasteful activities

• Low carbon alternatives – prioritising treatments and technologies with a lower environmental impact

Developed by Frances Mortimer at the Centre for Sustainable Healthcare Mortimer-F. The Sustainable Physician, Clinical Medicine 2010, Vol 10, No 2: 110–11

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SUSTAINABLE

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A. What is sustainable healthcare?

B. Why should healthcare professionals be concerned about sustainability?

C. What general steps have been taken to make healthcare more sustainable?

D. What steps have been taken towards sustainability in Dentistry?

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Working Groups

• CSH Sustainable Dentistry Programme wonderful dental scholars with input from Brett Duane

• Dental Sustainability Advisory Group

with representation from: GDC, BDA, LDC, PHE, HEE, CSH and many others

• Network Dental Susnethttps://networks.sustainablehealthcare.org.uk/network/dental-susnet

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Carbon footprinting and Triple Bottom Line

Analysis in Dentistry

• Taking a bite out of Scotland's dental carbon emissions in the transition to a low carbon future. Duane et al. Public Health 2012 Sep;126(9):770-7

• An estimated carbon footprint of NHS primary dental care within England. How can dentistry be more environmentally sustainable? Duane, B., Berners Lee, M., White, S., Stancliffe, R. & Steinbach, I. BDJ (2017) 223: 589–593

• Carbon Footprinting of Dentistry in England. Ingeborg Steinbach and Brett Duane, . PH England,

Please tweet, engage, get in touch!

www.sustainablehealthcare.org.ukhttps://networks.sustainablehealthcare.org.uk/network/dental-susnet

rachel@sustainablehealthcare.org.uk